The Hepatic System Flashcards
Liver
Sole source of albumin and other plasma proteins and also produces 500 to 1500 ml of bile each day
Functions of the Liver
More than 500 separate digestive, endocrine, excretory, and hematologic functions
With what does the liver interact with?
Endocrine and GI systems
Other functions
Other important functions of the liver include production of clotting factors and storage of vitamins.
What does the liver filter?
Filters all of the blood from the GI system
The liver is the storage location for what
Fat soluble vitamins, handles cholesterol homeostasis
Stores ions and copper, plays a role in hematology with clotting factors and protein synthesis
The liver and the gut are the key organs for what
nutrient absorption and metabolism
The liver has the largest numbers of phagocytic cells, why is that important?
It contributes to a functional immune system by reducing the amount of bacteria, viruses, and toxins that enter the body
Signs and Symptoms of Hepatic Disease
GI symptoms, edema/ascites, dark urine, light-colored or clay-colored feces, and right upper abdominal pain
Dark urine and Light stools
Occur when the serum bilirubin level increases from normal (0.1 to 1.0 mg/dl) to a value of 2 or 3 mg/dl
Skin changes
Associated with the hepatic system include jaundice, pallor, and orange or green skin
Spider angiomas
May be vascular manifestations of increased estrogen levels
Palmer erythema
Warm redness of the skin over the palms, also called liver palms
Neurologic symptoms
Such as confusion, sleep disturbances, muscle tremors, hyperactive reflexes, and asterixis, may occur
When can peripheral nerve function be impaired?
When liver dysfunction results in increased serum ammonia and urea levels
Asterixis (Flapping tremors or liver flap)
Motor disturbance
Inability to maintain wrist extension with forward of the UE
Test for asterixis is asking the client to extend the wrist and hand with the rest of the arm supported on a firm surface or with the arms held out in front of the body
Observe for quick, irregular extensions and flexions of the wrist
Where does pain present with hepatic disease
Locations of pain associated with hepatic and biliary systems include thoracic pain between scapulae, R shoulder, R UT, R interscapular, or R subscapular areas
Hepatic osteodystrophy
Abnormal development of bone, can occur in all forms of cholestasis (bile flow suppression) and hepatocellular disease
Bone pain
Osteoporosis
Osteomalacia (rare)
Both- decreased bone mass
Painful osteoarthropathy
Develops in the wrists and ankles as a nonspecific complication of chronic liver disease
Other Signs and Symptoms
Intense exercise should be avoided when the liver is compromised
Increased risk of coagulopathy also occurs with liver disease
Liver flap or asterixis can be observed in uremia, respiratory failure, and severe heart failure
Tremor is absent at rest, decreased by intentional movement, and maximal on sustained posture, (usually BIL)
Cirrhosis
A progressive loss of normal tissue that is replaced with fibrosis and nodular regeneration. Many diseases, medications, and toxins can damage the liver and ultimately lead to cirrhosis, but the most common in the United States include alcohol abuse, hepatitis C virus (HCV), and nonalcoholic liver disease
Hepatitis
Chronic and Viral
An acute or chronic inflammation of the liver caused by a virus, a chemical, a drug reaction, or alcohol abuse
Chronic Hepatitis
Comprises several diseases that are grouped together because they have common clinical manifestations and all are marked by chronic necroinflammatory injury that can lead insidiously to cirrhosis and end-stage liver disease
Causes of chronic hepatitis
Multiple causes including viruses, medications, metabolic abnormalities, and autoimmune disorders
Which ones can progress to chronic hepatitis?
Hepatitis B (HBV) with or without hepatitis D virus (HDV), HCV, and GB virus (GBV)
Viral Hepatitis
Each of the recognized hepatitis viruses belongs to a different virus family, and each has a unique epidemiology
Hep A
Pathogen: HAV, Picornaviridae
Symptoms: Fever, headache, malaise, jaundice
Incubation: 2-6 wks
Transmission: Ingestion
Test: IgM antibodies
Hep B
Pathogen: HBV, Hepadnaviridae
Symptoms: Severe liver damage, chronic disease occurs
Incubation: 3-26 wks
Transmission: Parenteral, sexual contact
Test: IgM antibodies
Hep C
Pathogen: HCV, Flaviviridae
Symptoms: Same as HBV, more chronic
Incubation: 2-33 wks
Transmission: Parenteral
Test: PCR of viral RNA
Hep D
Pathogen: HDV, Deltaviridae
Symptoms: Severe liver damage, high mortality rate
Incubation: 6-26 wks
Transmission: Parenteral, when coinfected with HBV
Test: IgM antibodies
Hep E
Pathogen: HEV, Caliciviridae
Symptoms: Pregnant women may be at high risk and show high mortality, not chronic disease
Incubation: 2-6 wks
Transmission: Ingestion
Test: IgM antibodies, PCR of viral RNA
Jaundice
Clinically characterized by yellow discoloration of the skin, sclerae, and mucous membranes. Jaundice occurs as a result of an overproduction of bilirubin, defects in bilirubin metabolism (in uptake by the liver or conjugation), the presence of liver disease, or obstruction of bile flow
Drug-Induced Liver Injury
Many drugs or toxins can cause injury to the liver
More than 1,000 medicinal agents, chemical, and herbal remedies are recognized as producing hepatic injury
Alcoholic Liver Disease (ALD)
Ranging from alcoholic steatosis (fatty liver, occurring in 90% of heavy drinkers) and alcoholic steatohepatitis to alcoholic hepatitis and cirrhosis
ALD Incidence/Risk Factors
Genetics
Women are vulnerable to developing ALD at lower daily intake levels of alcohol than men
Coexisting HCV, smoking, and obesity
ALD Pathogenesis
Accumulation of fat
Damage to the liver consisting of inflammation, necrosis of individual cells, and early fibrosis
Large nodules of fibrotic liver tissue
Reduction in oxidation of hepatic fatty acids=Increase lipogenesis
ALD Manifestations
Fatty liver infiltrate
Nausea, vomiting, abdominal pain, jaundice, anorexia, fever, and weight loss
What symptoms do people with alcoholic hepatitis or cirrhosis manifest?
Tender hepatomegaly, fever, and jaundice
Muscle wasting, spider angiomata, palmar erythema, gynecomastia, or testicular atrophy
Malignant Liver Neoplasms
4th leading cause of death from cancer worldwide and the 5th leading cause of cancer deaths among men in the US
Linked to cirrhosis, particularly HBV, HCV, and alcoholic-related cirrhosis
Metastatic Malignant Tumors
The liver is one of the most common sites of metastasis from other primary cancers (colorectal, stomach, pancreas, esophagus, lung, breast, melanoma)
Metastatic tumors occur 20x more often than primary liver tumors and constitute the bulk of hepatic malignancy
Pancreas
Both an exocrine and an endocrine gland. Its primary function in digestion is exocrine secretion of digestive enzymes and pancreatic juices, transported through the pancreatic duct to the duodenum
Pancreas Endocrine Function
Involves the secretion of glucagon and insulin by islet of Langerhans cells for the regulation of carbohydrate metabolism
Pancreatitis
Potentially serious inflammation of the pancreas and surrounding organs that may result in autodigestion of the pancreas by its own enzymes
Acute: brief and reversible
Chronic: recurrent or persisting
Acute Pancreatitis
An inflammatory process of the pancreas that can involve surrounding organs as well as cause a systemic reaction
Acute Pancreatitis Risk Factors
Alcohol
Gallstones
Hypertriglyceridemia
3 Levels of Acute Pancreatitis
- Mild-local or systemic complications in organ failure is absent
- Moderate-local complications with or without organ failure for less than 24 hours
- Severe-Persistent organ failure for more than 48 hours with involvement of one or more organs
Chronic Pancreatitis
Characterized by the development of irreversible changes in the pancreas secondary to chronic inflammation
Chronic Pancreatitis Risk Factors
Alcohol
Smoking
Genetic predisposition
Pancreatic Cancer
Represents the third leading cause of cancer mortality in the United States, with more than 45,000 deaths each year
Lowest 5-yr survival rate after diagnosis (9%) of any type of cancer
Pancreatic Cancer Symptoms
Initially nonspecific and vague or subtle in onset (e.g., anorexia, malaise, nausea, fatigue, pruritus), which contribute to the delay in diagnosis
Abdominal pain
Weight loss
Jaundice
Gallbladder
Acts as a reservoir for bile, stores and concentrates the bile during fasting periods and then contracts to expel the bile into the duodenum in response to the arrival of food
Bile
Helps in alkalinizing the intestinal contents and plays a role in the emulsification, absorption, and digestion of fat
Biliary System - Cholelithiasis (gallstone disease)
One of the most common GI diseases in the United States, occurring in an estimated 25 million people, or 10% to 15% of the adult population
Gallstones
Occurs when stones form in the bile at the gallbladder as a result of changes in the normal components of bile
Complications of Cholelithiasis
Choledocholithiasis
Defined as calculi in the common bile duct, choledocholithiasis occurs in 5% to 20% of persons with gallstones and has the same etiology and pathogenesis
Complications can be severe, including pancreatitis and cholangitis
Acute Cholangitis
Obstruction and stasis of bile from choledocholithiasis, biliary strictures, or malignancy can lead to a suppurative infection of the biliary tree
Acute Cholangitis Symptoms
Those in biliary obstruction (pain) plus fever and jaundice
Acute cholangitis can be categorized into three stages: grade I, mild; grade II, moderate; and grade III, severe
- Mild cholangitis does not meet the criteria for either severe or moderate cholangitis
- Moderate cholangitis have an elevated white blood cell count, fever, age over 75 years, hyperbilirubinemia, and hypoalbuminemia
- Severe acute cholangitis manifests with at least one new organ dysfunction
Acute Cholecystitis
Inflammation of the gallbladder, may be acute or chronic and occurs most often as a result of impaction of gallstones in the cystic duct, causing obstruction to bile flow and painful distention of the gallbladder
Asterixis
Motor disorder characterized by the intermittent loss of muscle tone when attempting to maintain a set position
